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The treatment of endocarditis by vancomycin
Abstract:
The narrow spectrum of vancomycin includes the common causal bacteria of endocarditis. This agent has been used since the 1960s for therapy and prophylaxis of infections when first-line drugs are inappropriate because of antibiotic resistance or drug allergy. Some personal experiences of vancomycin usage and a literature survey are presented in this paper which is based on the subdivision of endocarditis into medical, surgical (early--less than 60 days after operation--or late), and addict-related. The commonest bacterial causes of medical or late surgical infections are streptococci, and of the early surgical and addict-related infections are staphylococci. Vancomycin is bactericidal for Gram-positive cocci, except enterococci, but for optimal action it is arguable that combinations with gentamicin, fusidic acid, rifampicin or erythromycin should be used for staphylococcal endocarditis. The attainment of bactericidal blood levels may still be accompanied by failure of monotherapy and the need for early surgery is stressed. The prophylaxis of endocarditis is primarily required for tooth extraction and for cardiac surgery. The streptococci and staphylococci involved are normally vancomycin-susceptible, and the rabbit model shows that it is a suitable alternative to a beta-lactam and aminoglycoside combination. The combination is therefore suitable for patients already in hospital, especially those with prosthetic valves or undergoing cardiac surgery.
Insights
Vancomycin is effective for treating endocarditis caused by common bacteria like streptococci and staphylococci. Combination therapy may be needed for optimal outcomes, especially in complex cases requiring surgery.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Vancomycin has been a key antibiotic for endocarditis therapy and prophylaxis since the 1960s.
- It is used when first-line drugs are unsuitable due to antibiotic resistance or patient allergy.
- Endocarditis is categorized into medical, surgical (early/late), and addict-related types.
Purpose of the Study:
- To review vancomycin usage in different endocarditis subtypes.
- To assess the efficacy of vancomycin monotherapy versus combination therapy.
- To evaluate vancomycin's role in endocarditis prophylaxis.
Main Methods:
- Literature survey and personal clinical experience.
- Analysis of endocarditis cases based on medical, surgical, and addict-related classifications.
- Review of bacterial causes and antibiotic susceptibility patterns.
Main Results:
- Staphylococci are common in early surgical and addict-related endocarditis; streptococci in medical/late surgical.
- Vancomycin is bactericidal for Gram-positive cocci (except enterococci).
- Combination therapy (e.g., with gentamicin, rifampicin) may be crucial for staphylococcal endocarditis, and early surgery is emphasized.
Conclusions:
- Vancomycin is a viable alternative for prophylaxis in certain settings, including cardiac surgery.
- Achieving bactericidal levels does not guarantee monotherapy success, highlighting the need for combination therapy and surgical intervention.
- Vancomycin is suitable for prophylaxis in hospitalized patients, especially those with prosthetic valves.